All too often, family members, friends, fellow employees, and even therapists become reactive, judgmental, and walk on eggshells when they interact with someone who displays characteristics of borderline personality disorder. Let me start off by summarizing some of the core characteristics of the disorder, specifically focusing on those traits which play out in the interactions with others.

Affective Instability – This is where those with BPD struggle to regulate their emotions in predictable ways. Often, their mood does not match with expected life or social situations, thus making it difficult for those around them to understand or relate to the distress they are experiencing.

Fear of real or imagined abandonment – Those struggling with BPD are often afraid of being rejected, abandoned, or left alone emotionally. These feelings are triggered when the potential abandonment is indicated, as well as times where it isn’t.

Identity disturbance – It can be difficult for those with BPD to maintain a consistent sense of self. There is typically a variance of self-doubt, instability in self-image, and self-acceptance.

Impulsivity – Due to the emotional and personal instability, impulsivity is often a regular occurrence for those with BPD. While this may not feel disruptive for the individual, it can be highly disruptive for those around them.

Paranoid ideation and dissociative symptoms – In certain situations, those with BPD may struggle with feeling paranoid, especially in relation to how they perceive other’s intentions or motives. Also, they may experience dissociative symptoms, which is a disconnect from themselves, their reality, or their sense of self.

What we need to understand about personality disorders is that they are just that, disorders which occur within the core personality of the individual. This is important to consider, because it is extremely threatening to the individual when a personality disorder is suggested, or when a diagnosis is made, especially since it is difficult to be “objective” about your own personality. Because of this, it can be very threatening for someone experiencing symptoms of BPD to identify and accept that the symptoms are present in their life.

It is my professional belief that the symptoms of BPD are treatable, and that through treatment, people can reduce the identified symptoms to the degree that they no longer qualify for the diagnosis. This perspective can bring hope to those struggling with BPD, as well as those who are involved in their life. However, the process of therapy can be challenging, and typically requires long-term treatment.

Selecting a therapist who can treat BPD effectively is an important step in the process. The therapist must be able to accurately diagnose the disorder, as well as position themselves in the therapeutic relationship as to control for and manage the identified symptoms. A careful balance between soliciting BPD symptoms and maintaining safety and security within the therapeutic relationship is critical. Failure to challenge the BPD symptoms results in no change, while doing so without carefully creating a safe therapeutic relationship will typically result in early or even immediate rejection on the part of the client.

Once someone with BPD can effectively accept the diagnosis, identify how the symptoms play out in their life, and learn new ways of managing and responding to the symptoms, then they can focus on the primary relationships in their life, and work on how they relate to others in new ways.

Written by Dr. Tony Alonzo, DMFT, LMFT, CFLE therapist at the Holladay Center for Couples and Families

When you’re trying to create boundaries with people they will be tested. It’s like when cows enter a new pasture, they will knock their shoulder against the perimeter a few times to check out where their boundaries are and how strong they are. Cows are strong enough to take down barbed wire if they really wanted to, but they aren’t really testing if they can get out, they are testing if they are safe from the external world. Once they know that the boundaries are consistent and stable they feel safe and they graze in the middle. If the cows don’t have that consistent boundary they will rely on the cowboy to tell them when they have gone too far. The cowboy, however, doesn’t have consistent boundaries, they will only correct the cow when they notice the cow has gone too far, which doesn’t create a feeling of safety. People are the same when they have never experienced consistent boundaries, or they are experiencing new boundaries. People will test boundaries, not enough to break them but enough to trust that they are there to stay and to trust that they are there to keep them safe.

A lot of young adults who never experienced boundaries, because their parents wanted to be their friend. They have a great relationship with their parents, but they will tell me that they feel like they grew up as an orphan because they don’t have a secure home base. but they will tell me that they are afraid to explore and take risks as an adult because they can’t trust that they have parents who are watching out for them, to make sure they don’t make a mistake big enough to ruin their entire life.

It’s important that people are given the space to grow and find their own solutions within appropriate limits. When your setting limits the goal is not to get a specific outcome, rather the goal is to prevent a specific outcome. It is quite spectacular what people can come up with when their possibilities aren’t limited, but just the same we don’t want anyone hurting themselves or others in the process. Limits are set to prevent irreversible and/or irreplaceable damage, while still allowing people to learn how to cope with and improve from mistakes.

When cattle are being herded they have the instinct to turn around when they feel blocked, which can be disruptive to the flow and requires more work to redirect them back into the flow. To redirect a cow, you want them to feel pressure on their shoulder. If you are in front of them when you apply this pressure they feel blocked, if you are beside them when you apply this pressure they will simply turn a bit from where they shouldn’t be. People are the same, when they are told to stop doing what they are doing (and they don’t continue trampling over you) they will do a complete turnaround, even if this wasn’t your intention. If you’re only wanting a slight redirection from a no-go zone you want to adjust your approach to let them know that you understand that they want to move forward, and you want that too, but you want them going forward in a slightly different direction.

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In my career in healthcare, I have seen far too many patients who have been prescribed medication and continue to take that medication faithfully; Yet after a time, they are not really sure why they are taking that specific medication or if it is even helping with the diagnosed issue.

What is missing for these patients? Medication management.

Medication management is the process of following up with the healthcare provider on a regular basis to assess the effectiveness of the prescribed medication therapy, discuss any side effects that may go along with the medication, and make adjustments in order to achieve proper dosing. In some cases, the follow-up may be to change the prescribed medication therapy, if it is not providing the desired outcomes. Medication management should be an ongoing process. It should include open dialogue between the patient and provider about the effects of the medication combined with any other therapies or treatments that may be in place. This is to ensure useful data is being collected, so decisions can be made based on the whole picture; not just the medication piece.

When it comes to psychiatric and mental health services, the importance of quality medication management cannot be overemphasized. Not all people who seek psychiatric help will require medication. In some cases, amino acid therapy may be appropriate or continued therapy and counseling with regular psychiatric follow-up is warranted. If medication is prescribed, the patient should plan to see the psychiatric provider within 2 weeks (in most cases) for the first medication management visit. Continued follow-up visits should be scheduled monthly, or as needed depending on the individual case.

During these visits, the patient should plan on communicating openly with the psychiatric provider about their use of the medication, any side effects that they may be noticing, and any changes they are feeling in relation to their mental health diagnosis. At times, genetic testing can be used to pinpoint what medications are more likely to work for each individual patient. This testing can be used not only for patients who are just beginning psychiatric treatment but also for patients who have been prescribed medication therapies that aren’t working. The patient should also plan to consult with the psychiatric provider before taking any other medications. They should inform the provider of other mental health therapies being used or medical complications that may arise during treatment. The patient should expect the provider to ask questions that will direct and lead the conversation, so time is well spent and modifications can be made with confidence.

Ultimately, the key to effective psychiatric medication management is open and continual communication between the patient and provider. At the Center for Couples and Families, our psychiatric providers strive to provide thorough psychiatric assessment, follow-up, and medication management.

People are often worried about drudging up the past with their loved ones. There is controversy as to what is healthy for the relationship. People certainly don’t like to bring up an old fight when everything is going well. The issue is that we all have a closet of sorts where we hide everything that “isn’t worth the fight.” At first this closet is empty and the intention of putting things in there is good, you intend to talk about it later, it’s just not the right time.

The problem is that you enjoy the times you’re not fighting, who wouldn’t! You soon forget about what you’re storing in the closet, and you continue to throw everything “not worth the fight” into the closet. Your closet becomes full, and when you try to fit one more thing in there everything topples over. This is the fight of all fights, this is when you seemingly “loose it” out of nowhere about nothing and everything. This fight happens at a time when something was already “not worth the fight” and you were trying to put it in the closet. Therefore, you are probably not up for resolving everything in that closet either. It’s like if your junk closet toppled over just as company is coming over, you’re going to scoop everything up and stuff it back into the closet because you don’t have time to sort through it. This fight leaves everyone upset and confused and often nothing is resolved in this fight.

So how does one clean out this closet? Well its much like spring cleaning, you are going to take everything out and you begin to sort everything into categories. You evaluate if it is something that only happened once and will never happen again, if this is the case it truly isn’t worth the fight and can be thrown out. If it is something that continues to happen you need to address it, you will be bringing up the past not as a weapon against the other person, but as a justification for bringing it up as an issue. It is absolutely necessary that cleaning this closet is done at a time when your calm and you remain calm to be able to assess what the core of the problem is, what does their behavior tell you about your relationship with them. For instance, If someone is always late, how does their behavior effect you, why does it feel disrespectful to you and how does it create distance in your relationship, what is the message you receive about their feelings toward you. As opposed to judging their behavior as something you wouldn’t do and lecturing them about how it affects them.

When you clean out the closet you are transferring responsibility to the people it will be useful with. You will find that the cleaner your closet becomes the more clarity you will have in your relationships. Your intent in cleaning out the closet is not to change other people’s behavior, it is meant to change your relationships. You will find that some people will choose to become more distant because they are unwilling to make changes, but the relationships that become closer and the internal peace will be worth the distance in others.

Written by Madison Price, MS, LAMFT – therapist at Holladay Center for Couples and Families

Studies show about 1 out of every 6 adults will have depression at some time in their life. This means that you probably know someone who is depressed or may become depressed at some point. We often think of a depressed person as someone who is sad or melancholy. However, there are other signs of depression that can be a little more difficult to detect.

Trouble Sleeping

If you notice a change in a loved one’s sleeping habits pay close attention as this could be a sign of depression. Oftentimes depression leads to trouble sleeping and lack of sleep can also lead to depression.

Quick to Anger
When a person is depressed even everyday challenges can seem more difficult or even impossible to manage which often leads to increased anger and irritability. This can be especially true for adolescents and children.

Losing Interest
When someone is suffering from depression you may notice a lack of interest in past times he or she typically enjoys. “People suffering from clinical depression lose interest in favorite hobbies, friends, work — even food. It’s as if the brain’s pleasure circuits shut down or short out.”

Appetite Changes
Gary Kennedy, MD, director of geriatric psychiatry at Montefiore Medical Center in Bronx, New York cautions that a loss of appetite can be a sign of depression or even a sign of relapse back into depression. Dr. Kennedy also points out that others have trouble with overeating when they are depressed.

Low Self-Esteem

Depression often leaves people feeling down about themselves. Depression can lead to feelings of self-doubt and a negative attitude.

What to do
If you suspect you or someone you love may be suffering from depression talk about it, encourage him or her to get professional help and once he or she does be supportive. Remember thatat times symptoms of depression need to be treated just like any other medical condition.

Growing up, I would look through the newspaper to find the sports section, the funnies, and any other interesting articles I could find. However, I always seemed to come across the obituaries. I would stop and read them. Most people seemed to live a great life: loving families, great jobs, and lots of extracurricular activities. But, the thing that affected me the most was when at the end of the obituary, it would state something along the lines of, “in lieu of flowers please send money.” Today it looks a little different. There are no more newspaper obituaries, but instead online and social media declarations and announcements. Yet, one thing looks the same; instead of “in lieu of…” it now states “gofundme” or tells where an account has been set up at a local bank. The wording is different, but the intent is the same! That is why I strongly believe we need to address the topic of Life Insurance Myths and Misconception.

MYTHS

Life insurance is too expensive.

“86% of Americans say they haven’t bought life insurance because it’s “too expensive,” yet they overestimate its true cost by more than 2X”. * Believe it or not it’s not as expensive as you think. It could be half as much as you think.

Life insurance through my employer is enough.

“33% of Americans say they don’t have enough life insurance, including one-fourth who already own a policy”.* Some employers provide some life insurance for their employees; however, they normally offer 1 to 2 times your annual salary. Most likely that number doesn’t include commissions, bonuses, and other income. It is recommended that you have 8-12 times the annual income in life insurance coverage. (You may want to use a calculator to determine specific need.) Also, if you ever change jobs, get terminated, or retire, in most cases your life insurance coverage will not go with you. Depending on age and health, it could be less expensive to purchase and own your own policy. “Those with life insurance carry enough to replace their income for just 3.6 years. How would their families get by after that?”*

Stay-at-home parents don’t need it.

“Imagine if something were to happen to the stay-at-home spouse in your family. The breadwinner may need to hire someone to clean and take care of the kids, and that can cost a lot of money. Unless your family would have that extra income to spare, you may need life insurance on both spouses,” advises Marvin Feldman, President and CEO of life insurance non-profit organization, Life Happens. This also gives the remaining parent time to grieve, take care of kids, and take time off of work.

I’m too old or too young for life insurance.

Life insurance provides for the needs of those left behind. There are lots of different options for coverage no matter what stage of life you are in. And, as long as there is a need there should be coverage in place. Depending on age and health, different companies will provide different options. Work with a professional to help you cover that need.

“85% of Americans say most people need life insurance, yet only 62% have coverage.”* In fact, “3% say their cell phone is the most important, and 20% have cell phone insurance.”* Every person’s situation is unique and different. Some need a lot of coverage and some may not need any at all. But what I do know is that families need to be informed and educated on their options. Each person needs a plan…and “gofundme” isn’t a plan.

In cities throughout the world, notable high buildings and bridges increasingly have additional fencing built atop of them with the specific purpose of preventing suicides. Suicide fences tend to work because research has shown that suicidal actions are frequently impulsive, hence such fences serve to forestall that impulse and buy individuals precious time to further think about their decisions. In studies of suicide fences, it appears that individuals don’t leave such barriers to go look for another bridge or tall building to end their lives from, but instead return to the business of living for yet another day.

Presently suicide is the leading cause of death among young people ages 10-17 here in Utah, and over the last decade, it’s also doubled amongst adults in our state. As concerned friends, neighbors, and parents, how do we help our community build more barriers to suicide; protecting and empowering those we love? Over the next year, I’ll be writing a series of articles in answer to this question; offering my perspective as both a therapist, who has stood on sacred ground in helping others walk back from suicidal thinking, and as one who’s felt and ultimately rejected the dark pull to end my life amidst heavy times.

Perhaps you’ve already noted that there’s no way to build suicide fences everywhere or to somehow block all of the endless ways in which someone might consider ending their life. Sound public policies on prevention and physical barriers like suicide fences are only some of the important ways to help. So in addition to these forms of prevention, the focus of my writing will be on how to build barriers to suicide directly into the thinking and values of individuals, and into the culture of our community as a whole. In this first article, I want to introduce how we help foster an ethic to live within ourselves and in others as a key barrier to suicide.

An ethic to live means valuing our lives and holding a commitment within ourselves to continue living — even when we’re unsure of how we’ll cope or move forward. In my experience, helpful conversations about consciously building an ethic to live, begin by first taking care to turn our attention to the reality that to live is to be vulnerable to an array of difficult life experiences, with the potential to evoke within us the thought to end one’s life to escape them. Throughout human history, individuals and peoples have had to confront extremely painful and unjust challenges which have overwhelmed their sense of being able to continue on, and it’s important to acknowledge that when we confront such considerable pain, it is the most human thing in the world to want relief from it. This is real; excruciating human suffering beyond one’s current sense of how to reduce or stop it is real, and in these concentrations of pain, we may find ourselves having suicidal thoughts.

When we acknowledge and honor that such excruciating life experiences do show up for many of us, it’s then that we can locate where we need to begin building internal fences to prevent suicide. It’s here that we recognize the need to develop a strong ethic to live even though there are times that we might not yet fully know how we’ll cope or be able to see brighter ways forward. It’s also here that we find the need to define as individuals what makes life worth living with specificity to our own life experiences, as well as the need to find a listener who we can turn to and voice what’s going on inside of us.

As you navigate life’s difficulties, no matter how hard things may get, make the commitment now to live and identify your personal reasons to do so. Additionally, identify suicidal thoughts as a sign to find a listener who you feel safe enough to talk to. It’s worth thinking about right now who it is you might feel comfortable turning to during your hardest times. By doing so, you’ll begin to build your own internal fence between you and suicide as well as have greater insight as to how to help others you care about to do the same.

* If you or someone you care about is currently having thoughts of ending their life, caring help is available 24/7 by texting 741741 from anywhere in the USA or you can call 1-800-273-8255 to speak directly with a Counselor from the National Suicide Prevention Lifeline.

Bio: Laura Skaggs Dulin holds a master’s degree in Marriage and Family Therapy from San Diego State University. She currently sees clients at the Spanish Fork Center for Couples and Families and at Encircle LGBT Youth and Family Resource Center in Provo.

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Life Coaching is the favorite part of my job. I love sharing personal stories and real-world experiences as I help clients overcome addictions to food and other substances. When they understand that challenges with food are just symptoms of greater core issues, often related to emotions, they begin to overcome them as I teach how to change the behaviors for good.

I was a cake decorator for over thirty years. This was my life’s passion, but it ultimately ruined my health. Giving this dream up was a huge sacrifice but one that led to greater health, energy and joy in my life. From this experience and others, I understand what it feels like to be an addict and the behaviors associated with it. I also understand the emotions and fears that come when giving up comfort and an artificial kind of love.

Food is meant for fuel, nutrition and energy but we take it a step further and use it for comfort, love, and numbing out so we don’t have to feel what is truly going on inside. Emotional eating creates health challenges like addiction, obesity, fatigue, mental instability, and eating disorders of all kinds. It is fine to derive pleasure from food, but that should be a secondary result of making healthy food choices.

We know now that scientists have engineered processed food to increase our cravings and desire to keep coming back and purchasing their products. Sweet tastes, for example are what we are biologically programmed from infancy to gravitate toward. Mother’s milk is sweet and toddlers often choose fruit over vegetables. High fructose corn syrup is added to many products from ketchup to cereal to satisfy the cravings for sweets. The unfortunate consequence of eating it, however, is that it turns off the mechanism in our brain saying we are full, so we continue to eat until we are stuffed or feeling sick. Processed sugar feeds candida and causes a host of health problems if eaten regularly over time.

So, we are not completely to blame for our addictions, but there are things we can do to change our behaviors around food and make wiser choices that will reap greater benefits. As we enter a new year, I’d like to give 3 suggestions to help you make better decisions before going into the kitchen.

CREATE A PLAN: People who fail to plan, plan to fail right? Look through your recipe books and decide what to make for breakfast, lunch, dinner and snacks. Go shopping and get the ingredients needed.

PREPARE AHEAD:Prepare your mealsahead and refrigerate or freeze them for use throughout the week to save time and money.

ASK YOURSELF QUESTIONS: Sometimes we eat because we’re bored or tired and we aren’t even hungry. Here is a series of questions you can ask yourself before going to the refrigerator or pantry for a snack.

What do I want to eat?

Is it something that will give my body nutrition,fuel and sustained energy?

Why do I want it?

What emotion istied to thisfood?

Will _____ serve me for the better or worse?

What physical symptoms will I feelafter eating _______ ?

Is it worth it?

Asking yourself these questions will help you become conscious of your decisions and help make better ones. If you want to eat it, just because, then own that and don’t make yourself feel bad. Good habits are learned as we practice over time. Taking baby steps forward will help us see and feel the progress. Create a Happy New Year!

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Our community is the epitome of mainstream America. We have deeply rooted family values, safe streets, moral standards, and most families stand guarded against outside influences that threaten our happiness. Recently, however, Utah achieved the 7th highest drug overdose rate in the nation. How can a community named Happy Valley have some of the highest rates of adult mental illness and teenage suicide in the country?

Treating addiction is clearly a necessity. However, explaining these alarming and confusing statistics may also come down to understanding some myths, or assumptions, about happiness.

Myth No. 1: I Should Be HappyAll the Time

Some aspects of our local community amplify and reinforce the well-intended message that “good people” or “my kid” should not or would not encounter pain. At times, we may even feel entitled to getting our way and therefore feel betrayed when we stress and we encounter unwanted but normal life struggles. These challenges show up as: loneliness, divorce, work stress, relationship issues, domestic violence, bullying, prejudice, low self-esteem, and chronic pain to mention a few.

Myth No. 2: If I’m Not Happy, Something is Wrong with Me

For decades, mental health symptoms have been twisted and misunderstood to the point that painful or overwhelming thoughts and feelings are now presumed to be products of weak, faulty, and unworthy minds. Labels like ‘Anxious’, or ‘Addict’ are now used so frequently and in such negative ways it distracts us from the real issue at hand. Those labels not only build a wall but also mask the reality that we all struggle in similar ways. Combine these objectifying terms with a competitive culture this myth grows more powerful and exponential.

Myth No. 3: For a Better Life, I Must Get Rid Of Negative Feelings

Every single one of us experiences self-judgment, fear, and shame of not measuring up. It can be overwhelming and discouraging. Unfortunately, we live in a culture that promotes numbing and hiding as the solution to any pain or discomfort.

Anger, over-working, blaming, over-booking schedules, and isolation has been dependable sources of distraction for years. Some argue how safe and how little impact these behaviors have on themselves and others. Ironically, they assume that dependent or ‘addictive’ thinking and behaviors are only appropriate if describing illicit drugs and alcohol. Recently, more camouflaged options like sugar, caffeine, over the counter medication, smoking, power drinks, and trendy diets have become legal and justified ways to remedy unwanted thoughts or deal with social pressures. All of these behaviors, and others, are designed to alter reality, enhance social performance, and reduce stress. Unbeknownst to us, we end up trading one form of addiction for another.

Everyone considers himself or herself an unwilling and/or unaware accomplice and each would avoid the road of undue suffering if possible. Here are three practical take home ideas that can help you start breaking yourself free from the shackles of these myths and identify and strengthen your core values so you can stay connected with reality.

Take time and energy to notice core values that you have and may share with others. Write down and/or share thoughts, feelings, and memories that help identify and strengthen your core values. Yoga, meditation, and other quiet activities will improve focus and self-awareness.

Compare less. Look for opportunities to learn about and accept the uniqueness of others. Admitting and accepting our weakness and vulnerability to others actually creates meaningful emotional and social bonds.

React less. Take a deep breath and refocus values that you can practice today.

All of us long for acceptance, empathy, and connection from others but sometimes get stuck in the attractive web of addictive behaviors. If help is needed, reach out to others or professionals. Enjoy the search for happiness in the everyday pursuit of values, not distractions.

This time I was determined to fix this on my own. After all, I had a certification in corrective exercise, how could I not fix this? At that point I realized the only person that can help me was me. I was sick of paying chiropractors and doctors to temporarily ease the pain, but never giving me a path forward so that I could enjoy aggressive sports, lifting heavy, snowboarding, or whatever I felt like doing. I thought to myself, shouldn’t these professionals know how to fix this? Well yeah, but their answer was surgery. Not mine. By the way, I realize that sometimes the only answer is surgery in certain cases. And that’s okay. But I wanted to give my body a chance to see if I could figure this one out on my own. Feeling frustrated, but hopeful, I started to study every article about sacroiliac joint pain related to exercise and nursing it back to full strength, if it was even possible. There was a lot of trial and error, stumbling along the way, and figuring out which exercises were doable and which ones I needed to avoid. I slept different. I changed my posture. Patience was needed because this was a slow process. I slowly began building up my joint strength, my core strength, hip mobility, working in different planes of motion, and finally lifting heavier and heavier weight. I succeeded. I felt as if I had never experienced this injury because I was pain free and felt strong enough that I could do anything. This was probably one of the most satisfying experiences of overcoming something that seemed impossible to do.

I feel like we all have something like this, whether it is losing fat, getting stronger, eating healthier and living a healthy lifestyle, training for a difficult event, overcoming an injury, getting over an addiction, succeeding at a business or career, and so on and so forth. My challenge to you is to be patient and be hopeful. Don’t give up. If it’s worth it to you, then give it all that you can whether that be physically, mentally, emotionally, or spiritually. Be your best self. You have the potential and you are well worth it!